Merging departments saves $400,000
Benchmarking reduces duplication of services
What do you get when you merge patient advocacy and social services, then add utilization review? A new department called patient and family services, not to mention a $400,000 savings in labor, less duplication of services, and increased collaboration among staff, says Jackie Gonzalez, MSN, RN, director of operations for Miami Children’s Hospital.
The impetus for the merger came in 1995, when the facility began a comprehensive effort to reduce overall hospital costs by several million dollars. The patient advocacy department rose to the top of the cost-cutting list after Medical Management Planning (MMP), a benchmarking vendor based in Bainbridge, WA, provided a graph that couldn’t be ignored.
"Their worked hours per adjusted patient day were so high we had to scale down the graph in order to fit it on the paper, says Sharon Lau, an MMP consultant. The hospital scored nearly twice as high as the next poorest scoring facility and almost 13 times as high as the best performer.
To find out why, Gonzalez and the department directors and vice presidents of social work, patient advocacy, and utilization review studied three peer facilities with the following items in mind: department philosophies, hospital priorities, and job scope and function.
Based on that information, the team then selected Egleston Children’s Hospital in Atlanta for a site visit. The research showed them that clear lines need to be drawn between the function of social workers and patient advocates.
"Our patient advocates handle patient or family concerns that arise during the inpatient stay about the inpatient stay, whereas the social workers assess families’ psychosocial needs and help connect them to community resources," explains Ann Hunter, LCSW, Egleston’s manager of social work and child life department.
But at Miami Children’s, the functions of social services and patient advocacy often were redundant. "Although our patient advocates served as first line of defense when a parent is upset, they often took on more social worker type responsibilities than necessary," Gonzalez says. Communica-tion between the two departments also was difficult because they were located in different areas of the hospital.
Redefining job functions
To increase collaboration and eliminate duplication, the best practice called for merging the departments organizationally and physically relocating the new one. It also meant redetermining patient advocates’ essential job functions and realigning hospital priorities as FTEs were reduced from 13 to 7.8, including a 1.4 FTE chaplain position, Gonzalez notes. "We held meetings with all chiefs of medical divisions and departments to elicit their input into hospital priorities for family support. Clearly social service was their priority."
Now patient advocates concentrate their services in recovery, emergency, and urgent care.
Social services also was reduced from 23 to 17.5 FTEs. "Most were from positions of director, staff relieve, and secretarial support," Gonzalez says. Secretarial support for the new department was combined from both former departments.
Finally, in an effort to promote more efficient discharge planning, the utilization review (UR) department was moved under the new patient and family services department. A director, formerly from UR, was appointed director of all three merged services.
"These changes weren’t easy to implement, but they stimulated creativity and excitement in developing new methods of discharge planning and utilization of resources as well as teamwork," Gonzalez says.
For example, a new discharge planning screening tool is filled out within four hours by a nurse who does admission history, says Linda Marzano, the new director of patient and family services. "Then UR and social work can review the sheet before they make their multidisciplinary rounds," she says.
This method reduces redundancy between UR and social work. "Before, social services and utilization review might have both been working on concerns such as durable medical equipment. Now, we’re working as a team," Marzano says.
[Editor’s note: For more information, contact Jackie Gonzalez, MSN, Director of Operations, Miami Children’s Hospital, 3100 SW 62 Ave., Miami, FL 33155. Telephone: (305) 665-1576.]
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